For Varicose Veins, Laser Treatment Is Best

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When treating varicose veins, laser therapy remains the best
option, a new study says.

Researchers in the study examined 798 participants who had
varicose
veins and were treated at 11 vascular surgery centers in the
United Kingdom, between November 2008 and October 2012. The
participants underwent one of three types of treatments: closing
off the veins with a laser, injecting a drug "foam" into the vein
or surgically removing the vein.

After six months, the researchers compared the outcomes, looking
at how well the treatments worked and at their complication
rates, as well as how the participants rated the change in their
quality of life since their treatments.

"The main findings indicated that laser therapy was the preferred
treatment for varicose veins," said study author Dr. Julie
Brittenden, a professor in vascular surgery at the University of
Aberdeen in Scotland. "We found that all three treatments reduced
symptoms associated with varicose veins, but there were fewer
complications after laser treatment." [ 7
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What causes varicose veins?

Varicose veins are
blood vessels that have become swollen, enlarged and twisted.
Improperly working valves in the veins cause the disorder,
Brittenden explained. In people who have this condition, blood
returns up to the heart from the veins in the legs because of the
contraction of the calf muscles, she said. Normally, valves in
these veins prevent blood from flowing backwards, down towards
the feet.

"People with varicose veins have leaky valves, which means that
some blood flows backward and pools in the veins, causing them to
become enlarged," she said.

Foam treatment involves injecting drugs into a blood vessel. The
medicines, when mixed with air, cause the vessel wall to thicken,
which also helps to seal off blood flow. The recent study showed
that foam was less likely than the other treatments to completely
close a vein that had leaky valves, which may increase the
likelihood that a patient will need future treatment, Brittenden
said.

In the study, about 1 percent of patients who underwent treatment
with a laser experienced complications such as lumpiness, skin
staining and numbness. About 6 percent of those who received the
foam treatment, and 7 percent of those who underwent surgery
experienced such complications, according to the study.

The researchers also found that successful ablation of the great
saphenous vein occurred in 83 percent of those who received the
laser treatment and 84.4 percent of the participants who
underwent surgery. These numbers were significantly higher
than the 54.6 percent who had such successful ablation after the
foam treatment. The great saphenous vein, the longest in the
body, runs along the length of the leg.

The study appears in today's (September 24) issue of the New
England Journal of Medicine.

Dr. Kevin McMullen, a vascular surgeon at Surgical Hospital of
Oklahoma who was not involved with the study, said he agreed with
Brittenden's conclusion. "Laser is preferred over surgery or foam
due to higher success rates with the least amount of
complications," he said.

Laser therapy works better than foam on larger veins, as the
success rates for foam treatments worsens with increasing vein
size, McMullen said. However, surgery may be the best choice for
patients who have previously had vein procedures, or who have
anatomical issues, such as veins that are very
close to the skin or are larger than three-quarters of an inch
(20 millimeters) in diameter, he said.

Can varicose veins be prevented?

Varicose vein treatment is not done just for cosmetic reasons,
Brittenden said. "People with varicose veins often suffer from
aches and discomfort," she told Live Science. "The condition can
also cause swelling of the ankles, skin changes and sometimes
ulcers."

Both men and women get varicose veins, she said. The condition is
more common in pregnant women, older patients, overweight people
and those who stand for long periods. It is also more prevalent
in people who have a family history of varicose veins.

People can't prevent varicose veins from forming, but may be able
to delay their formation or prevent existing varicose veins from
getting worse, according to the National Institutes of Health.
The NIH recommends that people avoid standing or sitting for a
long time without taking breaks; avoid crossing their legs when
sitting; and keep their legs raised when sitting, resting or
sleeping.

Brittenden said that she and her team plan to follow the study
participants for five years, as long-term results are important
in determining longer-term costs and consequences of each of the
treatments, such as recurrent varicose veins.